SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Nielsen Kirk G.

(Last) (First) (Middle)
C/O INARI MEDICAL, INC.
9 PARKER, SUITE 100

(Street)
IRVINE CA 92618

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Inari Medical, Inc. [ NARI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
11/17/2020
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 11/17/2020 J(1) 3,004,415 D $0.00 2,705,162 I See footnote(2)
Common Stock 11/17/2020 J(3) 164,825 A $0.00 164,825 I See footnote(4)
Common Stock 11/17/2020 J(5) 164,825 D $0.00 0 I See footnote(4)
Common Stock 11/17/2020 J(6) 18,925 D $0.00 17,040 I See footnote(7)
Common Stock 11/17/2020 J(8) 8,837 A $0.00 8,837 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Versant Venture Capital IV, L.P. ("Versant IV"), to its partners, pursuant to a Rule 10b5-1 distribution plan.
2. Shares held by Versant IV. Versant Ventures IV, LLC ("Versant Ventures IV GP") is the general partner of Versant IV. The Reporting Person is a managing member of Versant Ventures IV GP and may be deemed to share voting and dispositive power over the shares held by Versant IV; however, he disclaims beneficial ownership of such securities, except to the extent of his pecuniary interests therein.
3. Represents a change in the form of ownership of Versant Ventures IV GP by virtue of the receipt of shares as a result of the pro-rata in-kind distribution of common stock of the Issuer for no consideration by Versant IV.
4. Shares held by Versant Ventures IV GP. The Reporting Person is a managing member of Versant Ventures IV GP and may be deemed to share voting and dispositive power over the shares held by Versant Ventures IV GP; however, he disclaims beneficial ownership of such securities, except to the extent of his pecuniary interests therein.
5. Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Versant Ventures IV GP to its members.
6. Represents a pro-rata distribution, and not a purchase or sale, without additional consideration by Versant Side Fund IV, L.P. ("Versant Side Fund"), to its partners, pursuant to a Rule 10b5-1 distribution plan.
7. Shares held by Versant Side Fund. Versant Ventures IV GP is the general partner of Versant Side Fund. The Reporting Person is a managing member of Versant Ventures IV GP and may be deemed to share voting and dispositive power over the shares held by Versant Side Fund; however, he disclaims beneficial ownership of such securities, except to the extent of his pecuniary interests therein.
8. Represents a change in the form of ownership of the Reporting Person by virtue of the receipt of shares as a result of the pro-rata in-kind distribution of common stock of the Issuer for no consideration by Versant Venture IV GP.
Remarks:
/s/ Robin L. Praeger, Attorney-in-Fact for Kirk Nielsen 11/19/2020
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.